[Vascular tunnel creation to improve the effect of decompressive craniectomy in severe traumatic cerebral edema]

More than million people/year die after head injury. The cause of death in 50% is the secondary brain swelling with incuneation. Today decompressive craniectomy with durotomy for traumatic brain swelling is performed as second--tier therapy at many clinics and hospitals. The literature mentions this method only as an option. The problem so far existed in the following fact: although the above mentioned method successfully diminished the ICP still despite this result, partial or total lesion occurred in the herniated part of the brain. The actual cause of these symptoms is found in the blockage of the veins and arteries, caused by shearing and compressive forces between the dural edge and brain tissue. Venous congestion induces further edema in the protruding parts of the brain, thus causing lesion by strangulated necrosis and hypoxia. The new surgical technique consists of a stellate manner durotomy and of creating a vascular tunnel by supporting pilasters made of haemostatic sponge around the main cortical veins and arteries of herniated brain. With the help of new technique the authors managed not only to reduce the intracranial pressure significantly but they could avoid further edema and vascular lesion as well. This due to the fact that with this method we assure the blood circulation and venous drainage of the herniated part of the brain. We think, that in this case despite of the initially severe status, the properly indicated combination of craniectomy, durotomy and vascular tunnel creation, could be the main factor of the surprisingly favorable outcome.